Re: Alexis Finlayson
ORB File No: 8294
Hearing held on: Friday, September 12, 2025
Place of hearing: St. Joseph's Healthcare Hamilton West 5th Campus, 100 West 5th Street
Pursuant to: Section 672.81(1) of the Criminal Code
Before:
Alternate Chairperson: Mr. C. MacIntyre, KC Members: Dr. P. Prendergast Dr. G. Nexhipi Mr. K. McKenna Mr. A. Mete
Parties Appearing:
Accused: Alexis Finlayson Counsel: Mr. A. Confente
The person in charge of hospital: Counsel: Mr. S. O’Brien
Attorney General of Ontario: Counsel: Ms. C. Gzik
REASONS FOR DISPOSITION
(Dated November 3, 2025)
Introduction
[1]. On May 8, 2023, Alexis Finlayson was found not criminally responsible on account of mental disorder on charges of assault with a weapon, utter a threat to cause death or bodily harm, mischief - not exceeding $5000, and possession of weapon for dangerous purpose, all contrary to the Criminal Code.
[2]. Ms. Finlayson is currently subject to an Ontario Review Board Disposition of August 16, 2024, which detains her at the Forensic Psychiatry Program of St. Joseph's Healthcare Hamilton (“St. Joseph's”), with privileges up to and including to live in the community in accommodation approved by the person in charge.
[3]. On September 12, 2025, the Ontario Review Board convened at St. Joseph's to conduct Ms. Finlayson's annual review and to make a disposition further to s. 672.81(1) of the Criminal Code. Ms. Finlayson was present as was her father, William Finlayson, and her stepmother, Shawna. This annual review had been rescheduled from Aug 05,2025, as a consequence of Dr. Nagari’s unavailability due to illness.
[4]. The parties were asked to present their preliminary positions. All parties agreed with the hospital’s recommendation that Ms. Finlayson receive a conditional discharge with terms and conditions as outlined by the hospital in its current Hospital Report of July 11, 2025, filed as an exhibit at today's hearing. One of the conditions proposed and agreed to was that Ms. Finlayson, on her consent, agree to take medication and treatment as prescribed by her psychiatrist in accordance with s. 672.55(1) of the Criminal Code. Ms. Finlayson’s counsel, Mr. Confente, advised at the outset that his client consents to that condition.
[5]. No issue was taken with Ms. Finlayson’s status as a significant threat to the safety of the public.
[6]. Dr. Nagari, Ms. Finlayson’s treating psychiatrist who gave evidence at today's hearing, advised that there is an error in the July 11 Hospital Report wherein it describes Ms. Finlayson as being treatment incapable. In fact, as of February 2025, she has been deemed treatment capable by Dr. Nagari. This oversight will be corrected in any subsequent Hospital Report.
Index Offences
[7]. The Hospital Report of July 11, 2025, outlines the circumstances of the index offence as follows:
“On Friday November 5, 2021 Police were dispatched to E[…] St, for a Domestic other type call in the city of Brantford.
The accused before the court, Alexis FINLAYSON, attended E[…] St after she was kicked out from Rosewood House. William FINLAYSON, Alexis’s father, advised Alexis that she is not welcome to stay there unless she receives some treatment for her Mental Health issues. Alexis became enraged and started screaming and swearing at William. Alexis entered the living room and kicked the television over. Alexis then went back to the kitchen and took a knife off of the kitchen counter, turned around and walked back towards William. Alexis raised the knife above her head in a “stabbing motion” and yelled “I’m going to fuckin kill you!” William backed up and believed that if he went near Alexis she would stab him. William advised that Alexis had a “glazed” over look in her eyes. William then called 911 and Alexis fled the house with the knife. William is very fearful of Alexis and advised that her mental health has been deteriorating and her behaviour has been escalating.
Alexis then went to 265 Elgin St and began kicking and punching a shed causing dents in it.
Alexis was located by Police approximately one block from the incident. Police observed bizarre behaviour from Alexis during their encounter. Alexis appeared to be talking and responding to people that were not there.
Police located a yellow knife at the bottom of the stairs by the entrance of E[…] St that was seized.
Alexis was bound by a Youth Probation Order with a start date of September 13, 2021 and end date of September 12, 2022 with the condition “do not possess any weapons or anything designed to be used or intended for use to cause death or injury or to threaten or intimidate any person”.
Subsequent to this investigation Alexis FINLAYSON is charged with the following offence:
Assault with a Weapon contrary to section 267 (a) of the Criminal Code of Canada (for walking towards William with the knife raised above her head).”
Background
[8]. Ms. Finlayson’s personal and psychiatric background is covered quite thoroughly in the Hospital Report of July 11, 2025.
[9]. In summary, she is now a 23-year-old woman whose birth parents were separated when she was six years old; she has resided with her father since then. According to her father, his daughter was free of behavioural or mental health issues until she had increased contact with her mother who was addicted to illicit substances. At a young age, Ms. Finlayson on several occasions, was exposed to a number of traumatic incidents involving her mother, including resuscitating her on many occasions. Ms. Finlayson was routinely exposed to drugs being around.
[10]. Ms. Finlayson’s father related that Ms. Finlayson began using cannabis as she spent more time with her biological mother and although she was enrolled in school, did not attend school. Eventually, Mr. Finlayson took over full custody of his daughter, but this was interrupted when she was in grade 9 when she began to take care of her mother. Ms. Finlayson’s mother was tragically murdered about five years ago.
[11]. Mr. Finlayson states that his daughter displayed significant rage issues beginning at the age of 14. She attacked him and damaged walls and furnishings in their house. She declined to speak to police who were called to complete wellness checks. Eventually when she was 17 years old, Mr. Finlayson demanded his daughter leave the house.
[12]. Ms. Finlayson reported that she first tried cannabis when she was 14 but did not use it daily until she was 18 years old.
[13]. The only recorded hospital admission related to mental health concerns was in July of 2018 when Ms. Finlayson was taken to the Hamilton Health Sciences McMaster's Children's Hospital after she attempted to assault her aunt. After 24 hours she was deemed appropriate for discharge into the care of her family with referral for Mental Health and Addiction Services and without any prescribed medication.
[14]. Ms. Finlayson’s only criminal record is a Youth Justice Court conviction for assault with intent to resist arrest for which she received a 12-month conditional discharge in September of 2021.
[15]. Ms. Finlayson was eventually diagnosed with schizophrenia and on May 8, 2023, she was found NCR based on that diagnosis. At her initial Review Board hearing, a Detention Order was issued with privileges up to living in the community in accommodation approved by the person in charge. On July 10, 2024, Ms. Finlayson was discharged from hospital to the community. At that time her presentation had improved significantly, however, there were concerns about continuing delusional beliefs and a history of non-adherence to prescribed medication. She was deemed incapable with respect to her ability to consent to treatment and her father became her Substitute Decision Maker.
Evidence at Hearing
[16]. Dr. Nagari provided evidence. He has been Ms. Finlayson’s attending psychiatrist from August of 2023 to the present. He testified that Ms. Finlayson has had a good past year. Since July of 2024, she has lived with her father and stepmother and has been supported by the Forensic Outpatient Team, CMHA and her family.
[17]. Ms. Finlayson has been entirely free of psychotic symptoms, and she is considered mentally stable. She is engaged with her caregivers and has attended all appointments and has been completely compliant with her prescribed medication. All screens for all substances have been negative and her insight has increased considerably.
[18]. As of February 2025, Dr. Nagari considered Ms. Finlayson treatment capable. At one point he had discussed with Ms. Finlayson a possible reduction in her medication, but she felt that she was doing so well on her current medication that she did not wish any change.
[19]. Since the end of July 2025, Ms. Finlayson has been working several hours per week as a cleaner. This provides her with some income in addition to her ODSP payments. Ms. Finlayson has successfully complied with taking her oral medications and she attends the outpatient clinic each month to receive her scheduled injection. She is independent in her activities of daily living and is engaged with her caregivers.
[20]. Ms. Finlayson has completed cognitive behavioural therapy for psychosis. This program includes training in abstinence from substance abuse.
[21]. Although Ms. Finlayson’s insight has greatly improved, Dr. Nagari testified that all her progress in the past year has been achieved in the context of strict external motivation. Dr. Nagari's opinion is that the condition in her Disposition requiring her to abstain from substances should now be removed but to have the testing provisions for substances remain. Dr. Nagari supports this change because she has remained abstinent in the past year and because her response to the removal of this mandated condition could help the team to measure how much of her commitment to abstain from substances can be internally motivated.
[22]. In an effort to provide community support for Ms. Finlayson, the Brantford ACTT team has been approached, however, it is unlikely that she will be accepted because of her higher level of functioning than those usually followed by ACTT teams. As an alternative, the outpatient team referred Ms. Finlayson to CMHA for case management, and she now receives peer support weekly and employment support from CMHA.
[23]. Ms. Finlayson wishes to become a personal support worker. Since her last Review Board hearing she has attended school to increase the credits towards her high school diploma and she graduated on June 25, 2025. Furthermore, she has obtained her GI driver’s licence and her forklift licence with a view to obtaining part-time employment in this sector. She has been actively pursuing part-time employment and she has applied for a PSW course in college.
[24]. Although the Hospital Report remarks that Ms. Finlayson initially expressed some reluctance to return to hospital if asked, she orally interjected at today's hearing to assert that she would definitely return to hospital if asked.
[25]. It is the hospital’s hope, and Ms. Finlayson's hope, that she can be connected with a community-based psychiatrist over the course of the next year.
[26]. As a result of the significant progress that Ms. Finlayson has made, Dr. Nagari and the hospital team are supporting the conditional discharge.
Analysis and Decision
[27]. The parties jointly acknowledge that Ms. Finlayson continues to represent a significant threat to the safety of the public. Dr. Nagari’s clinical risk summary states that:
“... some areas of concern remain that require ongoing monitoring and further education. She is yet to develop complete insight into her condition and associated risk – notably, she believes she is immune to future episodes of psychosis, which needs addressing through ongoing psychoeducation. She also exhibits some ambivalence in seeking help promptly if she were to experience any breakthrough symptoms, due to a fear of hospitalization. This hesitation may delay her access to care, potentially resulting in a deterioration of her mental health and an escalation of risk.
Although she has abstained from cannabis use under the conditions of her disposition, Ms. Finlayson has a history of regular use and remains at risk of relapse. Her abstinence has not yet been tested outside of a supervised setting. Additionally, she has a recent history of medication non- compliance, which warrants continued monitoring. Currently, no non-forensic community agency is involved in her care to provide adequate oversight or timely intervention in the event of instability.
... It is the unanimous opinion of the treatment team that the threshold for significant risk remains met at this time. ... it is foreseeable that, without supervision, Ms. Finlayson may discontinue her medication once again. ... symptoms, similar to those present at the time of the index offence, could result in aggressive and violent behaviour toward family members or others. ... the involvement of a weapon in the index offence raises the possibility of more serious harm.”
[28]. The Board adopts the evidence provided by Dr. Nagari which supports the joint acknowledgement that Ms. Finlayson meets the test of significant threat at this time.
[29]. The Review Board also accepts the encouraging evidence that supports the significant advances that Ms. Finlayson has made in the past reporting year. It seems clear that the efforts that she has made to improve her physical health, education, vocational training and vocational pursuits and to be fully compliant with the terms and conditions of her Disposition are indications of her wish to be well and to succeed.
[30]. The Board compliments Ms. Finlayson in her progress. In all the circumstances the Board considers that the least onerous and least restrictive Disposition at this time is a Conditional Discharge with the terms and conditions proposed by the hospital and agreed to by the parties. At this stage such an Order is necessary and appropriate for her continued treatment, rehabilitation and reintegration into the community and takes into account the safety interests of members of the public.
DATED this 3rd day of November 2025, at the City of Toronto, in the Region of Toronto.
Mr. C. MacIntyre, KC Alternate Chairperson
Office of the Registrar Ontario Review Board